While awareness of the condition is very sparse, sleep apnea is a very common condition. In fact, according to the National Institutes of Health, sleep apnea is as common as adult diabetes, and over 12 million Americans are affected by the condition.

The Centers for Medicare and Medicaid Services has proposed expanding Medicare’s coverage of continuous positive airway pressure therapy when it is used to treat obstructive sleep apnea. The new plan proposes to let people sleep in their own beds, using a home sleep test (HST), instead of spending the night in a sleep laboratory. Doctors will then review the results of the HST.

There is much debate over wheter this method is as effective as standard testing in lab. While the HST runs about $1,000 less than tests in a labratory and in most cases works equally as well, in some cases HSTs won’t signal if the patient doesn’t fall into a deep REM sleep where breathing is most likely to falter and therefore might not detect apnea.

When we first asked about medical home implementation in November 2006, more than half of 231 healthcare organizations reported that they were unfamiliar with the concept. (Get the results of that e-survey.) Today, it appears that the foundation has been built. Public payors have discovered its potential to extend and improve care to the medically underserved as well as reduce unnecessary emergency room visits. In the commercial sector, several pilot programs that incent physicians who tailor patient care to medical home tenets ??? including self-management education ??? are underway.

In this week’s issue, the Mayo Clinic’s Colleen Perkins shares some of the SMART points of the self-management education model for providers and health coaches. We also invite you to complete our follow-up e-survey on medical homes use. Take it by January 31 and receive a free e-summary of the results to learn how the medical home is fast becoming the heart of primary care.

Millions of Americans make the New Year???s resolution to stop smoking, but far too many break ranks before January 2. Their dismal success rate has health officials scrambling to come up with easier ways to quit, and many have toyed with the idea that smokeless tobacco could ease the transition off cigarettes. But research by University of Florida scientists suggests that tactic would be a catch-22, especially in younger smokers.

Promoting smokeless tobacco could encourage nonsmokers to pick up a dangerous and addictive habit.

Forty percent of 17-year-olds who were only using smokeless tobacco had either added cigarettes to the use of smokeless tobacco or completely switched to smoking four years later.

As patient volumes in hospital emergency departments (EDs) are going up, waiting times to see an ED physician are getting longer, particularly for heart attack patients and those in need of the most immediate attention, according to a study by Harvard Medical School researchers at the Cambridge Health Alliance. The researchers used 1997-2000 and 2003-2004 data from the National Hospital Ambulatory Medical Care Survey, conducted by the U.S. Census Bureau.

The median ED wait time went up from 22 minutes in 1997 to 30 minutes in 2004, a 36 percent increase.

For those identified in ED triage as needing attention ???emergently,??? wait times increased from 10 minutes in 1997 to 14 minutes in 2004, an increase of 40 percent.

A new study from the University of Michigan Health System and the VA Ann Arbor Healthcare System sheds light on the degree of disability among people with congestive heart failure (CHF), as well as the implications for the healthcare system, community care facilities, families and the patients themselves.

The study found that:

People with CHF were much more likely to receive informal (unpaid) home care from a relative or another unpaid person (42 percent) than people with coronary heart disease but no CHF (18 percent) and people without heart disease (11 percent).

An estimated 5.3 million Americans currently have CHF, according to the American Heart Association. Within six years of having a heart attack, about 22 percent of men and 46 percent of women will be disabled with CHF

Being a part of Generation Y myself, I’ve seen first-hand the evils of “tanorexia”. Many girls — and even some guys — of my generation have developed an obsessive love affair with not only Mr. Golden Sun, but Mr. UV Rays in any form, including tanning beds and stand-up tanning booths offered by salons.

As we Gen-Yers grew up with the Internet, surely the tanorexics among us know of the dangers both the sun and tanning salons can bring — the most serious (but definitely not the only) one being melonoma — but tragically, they don’t seem to care. Maybe it’s the “it can never happen to me” mentality, writing off any possibility of complications in the future, or maybe their mindset is more of a “look good now, pay later.”

Whatever the case may be, it’s a safe bet that extended, unprotected exposure to the sun, or any artificial likeness thereof, will only do harm. At the very least, think of the implications all these years of tanning mean for your skin as you age. I assume vanity is the reason for most tanorexics, so wouldn’t that be enough to stop them?

A press release from the University of New South Wales in Sydney, Australia notes that as Gen Y becomes more complacent with the risk of melanoma, it is up to the healthcare industry to improve means of communication with this generation regarding such diseases. In an effort to do so, an international project was launched that will conduct the first personalized online assessment of one’s melanoma risk. The project is part of the GenoMEL research program into all aspects of melanoma risk.

As flu season gets under way, employers are gearing up for more sick employees dragging themselves — and their germs — in to work. When sick employees show up for work, known as ???presenteeism,??? there is a significant and costly impact on an organization, not only in terms of risking the spread of disease, but also in diminished productivity, quality and attention to safety.

A study, performed by the 2007 CCH Unscheduled Absence Survey, found that:

Eighty-seven percent of employers report that sick employees who show up to work are suffering from short-term illnesses such as a cold or flu, which can be easily spread.

One in four organizations report they have a plan in place if a large percentage of employees become ill, indicating most organizations are less than well prepared in the event of a pandemic.

Each year, 11 to 15 of every 1,000 Americans visit a healthcare provider because of adverse drug events (ADEs). In dollars, ADEs are responsible for $2 billion per year in hospital costs nationwide, and measures as simple as improved care and reducing duplications of services can save healthcare organizations about $140 billion per year.

In this week’s Disease Management Update, new technology from the University of Michigan Health System is preventing potential medication errors, while Vermont hospitals are taking financial responsibility for improving patient safety and eliminating adverse events in general.

Adverse drug events (ADEs) are more apt to occur among older adults, as they are typically prescribed more medications and experience different effects from these drugs than younger people might. Statistics show that nearly 33 percent of older people who take at least five medications will experience an ADE each year. Of the 33 percent, nearly two-thirds will require some form of medical attention as a result of the ADE. Moreover, as much as 95 percent of these reactions are predictable, and over one-fourth percent are preventable, says Cung Pham, M.D., fellow in the Tufts University Family Medicine (TUSM) Residency at Cambridge Health Alliance’s Malden Family Medicine Center, and Robert Dickman, M.D., Jaharis Family Chair of Family Medicine at TUSM.

Published in American Family Physician, TUSM offers steps that all healthcare providers can take to avoid overuse, misuse and underuse of medication in older adults, and ultimately reduce ADEs as a whole. Highlights of the report include:

Avoiding misuse of medications: If a drug is listed on the Beers Criteria, a widely-adopted list of drugs that labels medications as “potentially inappropriate” for older persons or for older persons with specific medical conditions, the authors report that physicians can avoid those drugs apt to cause a severe adverse drug event simply by selecting alternatives. If there is no alternative, the best choice for a necessary drug is to start at the lowest effective dose and, when possible, discontinue the drug.

Avoiding overuse of medications: polypharmacy and overdosing Polymedicine describes the use of an increasing number of drugs related to an increasing number of medical problems, while polypharmacy is defined as inappropriate use of multiple drugs. While there is no standard marker for when a patient’s polymedicine list becomes polypharmacy, “increasing the number of medications increases the risk of drug-drug interactions and adverse drug events,” says Pham, “and reviews of medications should be routine.”

The “brown-bag” method, where patients bring all of their medications in a brown bag to the physician’s office, can lead to dropping at least one medicine in 20 percent of patients and a change in medication in 29 percent of patients.

Avoiding underuse of medication: underprescribing and nonadherence “Despite concerns about overprescribing, many conditions remain underdiagnosed or undertreated,” write the authors. “Ascribing all symptoms to degenerative disease or old age will potentially miss treatable conditions,” including heart disease, depression, osteoporosis and pain.

UAB Health System is one of a growing number of healthcare organizations extending the reach of its products and services via YouTube. The UAB ER rap video was conceived and created by UAB Health System’s ER nurses for a National Nurses’ Week contest and celebration. UAB Health System nurses and other staff members are featured in the video. The Alabama-based health system hasplaced 125 mostly educational videos on YouTube, and has made them viewable from its own Web site.

UAB Health System’s Internet Marketing Manager Susan Reid will detail the organization’s Web 2.0 strategy during Emerging Trends & Opportunities for Healthcare Organizations to Leverage Web 2.0, a February 13, 2008 interactive webinar. Also on the agenda are highlights from the Web 2.0 technologies employed by the Cleveland Clinic and Medical University of South Carolina.